DR. LEE AKST –OTOLARYNGOLOGY LOYOLA UNIVERSITY MEDICAL CENTER 2160 South First Avenue Maywood, Illinois 60153 Office - 708-216-9183 Fax- 708-216-4834 Nursing Triage-708-216-9183 Appointments- 708-216-8563 24 Hour Answering Service – 708-216-8000 (Emergency)
Laryngopharyngeal Reflux (LPR) and Vocal Difficulty Your stomach produces acid to help break down food so it is easier to digest. It is prevented from backing up or refluxing into your esophagus (food pipe) and throat by a band of muscle at the top of the stomach known as the lower esophageal sphincter. If stomach acid comes up into the esophagus, it is termed Gastro-Esophageal Reflux (GER). There is another valve at the top of the esophagus, the upper esophageal sphincter. If this band of muscle is not functioning well, you can have a backflow of acid up into the sensitive tissue at the back of the throat, larynx (voice box), and even the back of the nasal airway. This is called laryngopharyngeal reflux (LPR). LPR is different than gastro-esophageal reflux (GER). Typically, individuals with GER suffer from heartburn. Although some persons with LPR do suffer from heartburn, most persons with LPR do not. LPR can also affect the lungs and may exacerbate asthma, emphysema, or bronchitis. Some vocal symptoms result from direct irritation from acidic stomas secretions, while other symptoms may result from tightening of the muscles in the larynx, and neck in response to the irritation. The following are symptoms that may be consistent with acid reflux irritation:
¾ Feeling like you are choking ¾ Chronic
¾ Cough that wakes you from your sleep ¾ Hoarseness ¾ Trouble
¾ Sensation of having “a lump in the throat” ¾ Thick or too much mucous ¾ Sour or acidic taste in mouth ¾ Recurrent sore throat
Treatment for LPR involves keeping stomach contents where they belong and neutralizing stomach acid. To help Manage reflux, the following diet and lifestyle changes are recommended.
¾ Obesity promotes reflux. Lose weight, if you need to. ¾ Avoid tight clothing around the midsection of the body and avoid bending after meals, both of which
squeeze the abdomen and increases the chances of reflux.
¾ Do not exercise after meals or within two hours of bedtime. ¾ Reduce stress. Stress can create increased acid secretion. ¾ Limit aspirin and ibuprofen. They m ay increase stomach irritation. ¾ Stop smoking as nicotine increases reflux tendencies. ¾ Elevate the head of your bed on blocks, 4 to 6 inches. Extra pillows are not as effective. ¾ Watch when you eat:
o Eat dinner at least 2-3 hoursbefore you lie down. o Do not snack after the evening meal. o Eating more frequent, smaller meals may help reduce reflux tendencies.
¾ Watch what you eat:
o Avoid fatty foods. High fat foods can increase acid secretion, decrease lower esophageal
Function, or slow down the emptying of the stomach.
o Avoid spicy foods. Some spices may irritate the esophageal lining. o Eat fewer acidic foods. Some spices may irritate the esophageal lining.
o Limit chocolate, nuts, peppermint, alcohol, caffeine, and fizzy beverages. These affect the lower
esophageal sphincter and increase the likelihood of reflux.
DIETARY PLAN FOOD GROUPS Recommend Avoid/Limit Consumption
Fried or creamy style vegetables, tomatoes
decaffeinated), carbonated beverages, tea
Medication for Acid Reflux
Along with diet and lifestyle changes, your doctor may prescribe medication to help treat your acid reflux. The choice of medication will be based on you symptoms and test results. As with any medication, if you experience side effects, call your doctor. ¾ Reducing Stomach Acid: Your doctor may suggest antacids that you can buy over the counter (i.e., Tums, Mylanta, Maalox), or you may be told to take a type of medication called H-2 blockers (i.e., Tagamet, Pepcid, Zantac). They block histamine 2, which signals the stomach to make acid.
¾ Blocking Stomach Acid: In more sever cases, your doctor may prescribe stronger medication (i.e., Proton pump inhibitors (Protonix, Prevacid, Nexium). Theses inhibit acid secretion.
You hold the key to controlling reflux. Work with your physician, take any medications as directed, and
follow the diet and lifestyle changes detailed in this handout. In this way, you can help free yourself from the symptoms of laryngopharyngeal reflux (LPR).
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